Pulpotomy in mature permanent teeth - Part II
12/01/2023
Fitim Shabani
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There are three techniques available for treatment of immature permanent teeth with exposed vital pulps: direct pulp capping, partial pulpotomy and complete pulpotomy.
Indication for permanent tooth pulpotomy :
- Tooth has no history of spontaneous pain
- Tooth has no discomfort to percussion, no vestibular swelling and no mobility
- Radiographic examination shows normal appearance of periodontal attachment
- Pulp is exposed during caries removal or subsequent to recent trauma
- Tissue appears vital
- Bleeding from the pulp exposure, stops with isotonic saline irrigation within 3minutes.
Fig. 1
Clinical data
Age : Female 17 years old
Tooth : Second mandibular right molar
Dg : Deep caries with pulp penetrating
Treatment plan : Pulpotomy
Fig. 2
Pre-operative X-ray
Fig. 3
Isolation, initial preparation which has resulted in pulp opening.
Fig. 4
Caries removal prior to pulpal access is required to reduce the bacterial load.
Haemostasis – cotton pellet within 3min.
Fig. 5
MTA (mineral trioxide aggregate) was placed against the wound.
Fig. 6
Composite restoration
Fig. 7
X-ray after 1.5 year
The patien has no complaints
The vitality test – positive delayed
Conclusions
Pulpotomy is a prospective substitute for root canal treatment in managing permanent teeth with carious pulp exposures, even in permanent teeth with irreversible pulpitis.
Large, well-designed trials comparing pulpotomy with other treatments in terms of cost-effectiveness should be informative.
Bibliography
1. Endodontists A. Glossary of Endodontic Terms. Chicago: American Association of Endodontists; 2012.
2. Taha NA, Abdelkhader SZ. Outcome of full pulpotomy using Biodentine in adult patients with symptoms indicative of irreversible pulpitis. Int Endod J. 2018;51:819–28.
3. Qudeimat MA, Alyahya A, Hasan AA. Mineral trioxide aggregate pulpotomy for permanent molars with clinical signs indicative of irreversible pulpitis: A preliminary study. Int Endod J. 2017;50:126–34.
4. McDonald RE, Avery DR, Dean JA. Treatment of deep caries, vital pulp exposure and pulpless teeth. In: Dentistry for the Child and Adolescent. 8th ed. St. Louis: Mosby: 2004. pp. 389–412.
5. Linsuwanont P, Wimonsutthikul K, Pothimoke U, Santiwong B. Treatment outcomes of mineral trioxide aggregate pulpotomy in vital permanent teeth with carious pulp exposure: The retrospective study. J Endod. 2017;43:225–30.
6. Yuanyuan Li 1, Bingdong Sui 2, Christian Dahl 3, Brian Bergeron 3, Peter Shipman 4, Lina Niu 5, Jihua Chen 6, Franklin R Tay 7 Pulpotomy for carious pulp exposures in permanent teeth: A systematic review and meta-analysis. In : J Dent, May 2019
